The interface between child and adult mental health services

The divide between services for children and adults with mental health problems continues, so I was pleased to read the article by Singh et al (Psychiatric Bulletin, August 2005, 29, 292–294) which draws our attention to this matter again. However, I think that more emphasis should have been placed on the important role of training, particularly for junior psychiatrists and general practitioners (GPs) who will be in the vanguard of developing or commissioning services in the future.

With this in mind, I have started to run an induction session in child psychiatry for our child and adolescent mental health service (CAMHS) in Plymouth. This began as an hour but is now half a day and may shortly be a day-long event. It is intended for new senior house officers in psychiatry, who may be career psychiatrists or vocational GP trainees, and occurs every 6 months as part of their routine induction programme. The evaluation of these sessions has been very positive, with all trainees so far finding the sessions ‘ useful’ or ‘very useful’. This is the main reason that the length of the session will be extended: it seems to be filling a training need which is probably not met elsewhere. General practitioners not only have to deal with a considerable burden of psychiatric illness of both adults and children in primary care, but also receive very little training for this. Foreman (2001), for example, found that 47% of GPs sampled had no undergraduate training in CAMHS and 93% had negligible postgraduate experience.

The session includes an initial introduction to the CAMHS, followed by sections on self-harm and the local protocol for its assessment in young people, and the effects of parental mental illness on children. The second half of the session covers conditions commonly seen in a CAMHS which will continue into adult life, such as attention-deficit hyperactivity disorder and autistic-spectrum disorder. The teaching is interactive and videos provide a focus for discussion.

I would be interested to hear of other developments in CAMHS throughout the country on GP training in child and adolescent psychiatry. Perhaps the College should be developing an initiative to this end?